Bisphosphonates are drugs taken by some cancer patients to treat bone-related side effects.

Bisphosphonates are drugs given to some patients whose cancer has spread to the bones. They are used to reduce pain and decrease the risk of broken bones. (See the PDQ summary on Pain ¹ for more information.) Bisphosphonates are also used to treat hypercalcemia (too much calcium in the blood). Some cancer cells secrete substances that cause calcium to be absorbed into the bloodstream from bones. (See the PDQ summary on Hypercalcemia ² for more information.)

Certain bisphosphonates are linked to a risk of bone loss.

Certain bisphosphonates are linked to the breakdown of bone in the mouth, usually the jaw. This is called bisphosphonate-associated osteonecrosis (BON). It occurs more often in patients taking intravenous bisphosphonates, but it sometimes develops in patients taking them by mouth. Symptoms include pain and inflamed lesions in the mouth, where areas of damaged bone may be seen. There are many patients who take bisphosphonates, but the number who develop BON is small.

BON most commonly occurs after oral surgery.

BON most commonly occurs after a dental procedure such as having a tooth pulled. The area fails to heal for weeks after the procedure. If not treated, the areas of bone loss and the lesions can become very large and infected. These patients may develop paresthesia, an abnormal feeling on the skin, such as burning or prickling, that occurs without any known physical cause. Patients with severe BON may need to be treated in a hospital or have part of the jawbone removed.

It is less common for BON to occur in patients who have not had dental procedures.

Treatment of BON usually includes treating the infection and good dental hygiene.

Treatment of BON may include the following:

• Removing the infected tissue.
• Smoothing sharp edges of exposed bone.
• Taking antibiotics to fight infection.
• Using medicated mouth rinses.

During treatment for BON, the patient should continue to brush and floss the teeth after meals to keep the mouth very clean. Avoiding tobacco use while BON is healing may be advised.

Stopping the use of the bisphosphonate is a decision to be made by the patient and doctor, based on the effect it would have on the patient's general health.

New types of bisphosphonates are being studied in clinical trials. The use of hyperbaric oxygen therapy (HBO) combined with stopping the use of bisphosphonates is under study for the treatment of BON. It is not known if tobacco use increases the risk of developing BON.

Glossary Terms

Not normal. An abnormal lesion or growth may be cancerous, premalignant (likely to become cancer), or benign.

A drug used to treat infections caused by bacteria and other microorganisms.

A drug or substance used to treat hypercalcemia (abnormally high blood calcium) and bone pain caused by some types of cancer. Forms of bisphosphonates are also used to treat osteoporosis and for bone imaging. Bisphosphonates inhibit a type of bone cell that breaks down bone. Also called diphosphonate.

The necrosis (death) of bone tissue caused by treatment with a bisphosphonate (a drug or substance used to treat osteoporosis, bone pain caused by some types of cancer, and high blood calcium). It commonly occurs in the jaw bones. There may be pain, swelling and infection in the areas of necrosis. Also called BON.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

A mineral found in teeth, bones, and other body tissues.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied.

Higher than normal levels of calcium in the blood. Some types of cancer increase the risk of hypercalcemia.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.

Into or within a vein. Intravenous usually refers to a way of giving a drug or other substance through a needle or tube inserted into a vein. Also called I.V..

An area of abnormal tissue. A lesion may be benign (noncancerous) or malignant (cancerous).

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

An abnormal touch sensation, such as burning or prickling, that occurs without an outside stimulus.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment.

A group or layer of cells that work together to perform a specific function.

A plant with leaves that have high levels of the addictive chemical nicotine. The leaves may be smoked (in cigarettes, cigars, and pipes), applied to the gums (as dipping and chewing tobacco), or inhaled (as snuff). Tobacco leaves also contain many cancer-causing chemicals, and tobacco use and exposure to secondhand tobacco smoke have been linked to many types of cancer and other diseases. The scientific name is Nicotiana tabacum.